Lacrimal disorders
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Transcript of Lacrimal disorders
LACRIMAL DISORDERS
Objectives: Preview
• Anatomy & Physiology• Approach • Pathology – Cong NLD Obst– Lacrimal system infections• Acute• Chronic
Anatomy
• Secretory– LG• Tears
• Excretory– NLS• Passive • Active (pump)
HYPER
LACRIMATION
Causes of tearing
Lid : Malposition,Facial palsy, Punctal stenosisConj&Cornea: Abrasion, FB, KeratitisGlaucoma NLD obstruction
Approach
• Symptoms– Tearing– Discharges– Swelling
• POH– med & surg
• Visual acuity: VA– 6/60– HM– LP– NLP
• Lacrimal sac swelling• Regurgitation– On pressure reflux of purulent material from punctum
• Lids– Swelling – Punctum
• Conjunctiva• Tear film• Cornea
Dye disappearance test DDT
Place a drop of fluorescein in each eye, and monitor with cobalt blue light; if a pool is still present after 5 minutes the test is positive.
Dry eye: Tear break-up time: trachoma
Schirmer test: Sjogren syndrome
Pathology
Congenital nasolacrimal duct obstruction
•Delayed canalization
•NLD obstruction occurs in 2% of newborns
•Can be bilateral
•Reflux of purulent material from punctum
•Role out congenital glaucoma
•Usually resolve during the first year of life
Management Medical • Massage of nasolacrimal duct
(hydrostatic pressure)• Antibiotic drops..
Surgical • Probing• Intubation • DCR
Pathology
• Redness • Discharges • Epiphora• Canthal swelling,
below inner canthus• Tenderness
• Usually secondary to NLD
obstruction and tear stasis
Acute Dacryocystitis
Complications
• Lacrimal abscess• Presptal Cellulitis• Orbital Cellulitis
– Orbital Abscess– CST– Brain Abscess– Death
Medical Surgical
Rx
Pathology
Epiphora and chronic or recurrent unilateral conjunctivitis
Expressed mucopurulent discharge Painless swelling at inner canthus
Treatment – DCR
Chronic Dacryocystitis
DacryocystorhinostomyDCR
Review• Anatomy • Physiology• Approach• Causes of the watery eyes• Cong NLD Obst• Lacrimal system infections: – Acute?– Chronic?
Problem solving• NLD obstruction + Cataract
Lecture Evaluation: poor-fair-very good
1. How would you grade it2. How would you grade yourself3. comments
QuizSigns of acute dacryocystitis:Dry eyesPainless swelling Proptosis
Nasolacrimal duct opens-in the nose- at:Superior meatus Middle meatusInferior meatus